=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770853541
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADAM HARSANY DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2012
-----------------------------------------------------
Last Update Date | 01/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3030 BEARD RD
-----------------------------------------------------
City | NAPA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94558-3490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-255-3511
-----------------------------------------------------
Fax | 707-255-9503
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3030 BEARD RD
-----------------------------------------------------
City | NAPA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94558-3490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-255-3511
-----------------------------------------------------
Fax | 707-255-9503
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 44319
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------